Monday, May 19, 2008

Well, that's the idea anyway. When a medical mistake happens, very often everyone knows there was a screw up, including the patient. But doctors are told by their malpractice insurance to deny, deny, deny. That advice has changed to apologize, apologize, apologize:

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

One of the biggest problems with the "deny" mantra is that the hospital and doctor don't do an adequate correction of errors after a mistake, because, of course, there was no mistake. This reasoning is stupid, but it happens. Sometimes the process is the problem. Sometimes the environment is the problem. Or staffing. Or maybe, the doctor is just plain tired. Maybe the doc makes all his mistakes during surgeries between 10 and midnight. Unfortunately, the focus is on the success of the procedure, not the success of the outcome. There are many moving parts when a person ends up in the hospital. Denying and defending against all and any mistakes makes for a defensive environment where solution-oriented change doesn't happen. Or not very quickly at any rate.

The results of admitting errors has been encouraging:

Mr. Boothman emphasized that he could not know whether the decline was due to disclosure or safer medicine, or both. But the hospital’s legal defense costs and the money it must set aside to pay claims have each been cut by two-thirds, he said. The time taken to dispose of cases has been halved.

The number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago, said Dr. Timothy B. McDonald, the hospital’s chief safety and risk officer. In the 37 cases where the hospital acknowledged a preventable error and apologized, only one patient has filed suit. Only six settlements have exceeded the hospital’s medical and related expenses.

More than the money or correction of errors, admitting fault is just the right thing to do. When a person screws up, especially on your body (this isn't a car or landscaping after all), it seems only right to apologize and not charge the person, at the very least. Even better, get the person the corrective care they need. This is just basic customer service. Doctors, surgeons especially, have earned the arrogant rap for a reason. Everyone screws up. And even doctors need to know how to say, "I'm sorry".